Application Check List

Transcription

1 Application Check List Application Form Please complete the entire application form. Admissions Essay Complete the four parts of the Admissions Essay (see form in application packet). Please type your responses and attach to the application. Three Letters of Recommendation Letters of recommendation should be from persons who are familiar with your personal, academic and professional background, who understand your educational goals, and who can address your ability to pursue doctoral study in your chosen field. Forms for the letters of recommendation are included with this application packet. Complete the applicant s portion and provide the form and an addressed envelope to each person providing a recommendation. The letters must be returned directly to the PhD Program Office by the recommenders. Transcripts Using the forms provided in the application packet, request one official transcript from each educational institution you attended. All official transcripts must be received by the PhD Program Office, unopened, directly from the college or university. Resume Attach a current resume that includes: work history (paid and volunteer), education, experience in conducting research, community leadership roles, membership in professional organizations, honors and awards, presentations and publications. Research-Oriented Writing Sample Please submit with your application a sample of your past work that gives some indication of your research skills, writing abilities, and critical thinking skills. Please note that the writing sample will not be returned. Computer Equipment and Skills Assessment Form Please complete the enclosed Computer Equipment and Skills Assessment Form and return it with your application. Application Fee A non-refundable fee of $100 in U.S. funds, payable to Antioch University should accompany the application. If you are interested in paying through a credit card, please contact the Program Office directly. Application Submission Please do not bind application materials. Please send/deliver all application materials (except transcripts and recommendations) in a single package to: PhD in Leadership and Change Program Office Antioch University 900 Dayton Street Yellow Springs, OH Questions regarding your application may be directed to the Program Office by calling or toll-free , by faxing , or by ing admissions.phdlc@antioch.edu. Please note: All materials submitted for application to the PhD Program become the property of the PhD Program.

2 University Profile Be ashamed to die until you have won some victory for humanity. Horace Mann, Antioch s First President, 1859 From its origins as one of America s most innovative liberal arts colleges, Antioch University today stands as a distinctive institution of higher learning, with geographically dispersed campuses offering an array of undergraduate and graduate programs to students of all ages. The core of Antioch University s educational mission is a focus on the student learner and on the belief that the role of education is to help students in the purposeful pursuit of a meaningful life. All University programs reflect an education model that integrates intellectual and experiential learning, along with community participation and service. Antioch University has been a pioneer in several notable areas, including cooperative education, study abroad programs, campus-based participatory governance, serving adult learners, documentation and assessment of life experience, and the integration of experiential learning and academic study. Antioch University 888 Dayton Street, Suite 102 Yellow Springs, OH PhD in Leadership and Change Program Antioch University 900 Dayton Street Yellow Springs, OH Antioch University Education Abroad Antioch University 900 Dayton Street Yellow Springs, OH Antioch University Los Angeles 400 Corporate Pointe Culver City, CA Antioch University Midwest 900 Dayton Street Yellow Springs, OH midwest.antioch.edu Antioch University New England 40 Avon Street Keene, NH Antioch University Santa Barbara 602 Anacapa Street Santa Barbara, CA Antioch University Seattle 2326 Sixth Avenue Seattle, WA Antioch University s Mission Antioch University provides learner-centered education to empower students with the knowledge and skills to lead meaningful lives and to advance social, economic, and environmental justice. Antioch University is fully accredited by the Higher Learning Commission of the North Central Association of Colleges and Schools. To learn more about Antioch University s multi-campus system visit

3 Application for Admission please print or type Full Legal Name (Last, First, Middle / Maiden) Please list all other names under which transcripts and other credentials may arrive Preferred Name / Nickname Social Security Number Home Address (Street, City, State, Zip) Work Address (Street, City, State, Zip) Which address is your preferred mailing address: Work Home Home Phone (with area code) Cell Phone (with area code) Work Phone (with area code) Fax (with area code) Address Occupation Ethnicity/Race Antioch University seeks to draw students from all racial, ethnic, gender and age groups. This will help us provide equal educational opportunities to all our applicants, and to use for educational reporting purposes. Please mark appropriate box(es): African American / Black Native American / Alaska Native Asian American / Asian Mexican American / Mexican Filipino(a) Japanese American / Japanese Bi-Ethnic / Bi-Racial Native Hawaiian / Pacific Islander East Indian / Pakistani Other Asian Euro American / White / Caucasian Central American Hispanic American / Hispanic / Latino(a) Cuban Chinese American / Chinese Middle Eastern Korean American / Korean I choose not to respond Date of Birth Gender Citizenship Financial Aid Are you going to apply for Financial Aid Application through the Department of Education? Yes No This can be done electronically by going to fafsa.ed.gov. The Program s school code is Are you eligible for Veteran s Benefits? Yes No Will your employer be assisting you financially? Yes No Will you be applying for the Guskin Scholarship? Yes No

4 Application for Admission (continued) please print or type Employment Experience Please begin with your current employment and go back no further than 10 years. Attach additional sheets if necessary. Employer: Name, City, State Professional Position Dates of Employment Employer: Name, City, State Professional Position Dates of Employment Employer: Name, City, State Professional Position Dates of Employment Academic History Please list all colleges and universities you have attended. Official transcripts from all institutions are required. Attach additional sheets if necessary. Institution: Name Dates of Attendance Degree Received, City, State Institution: Name Dates of Attendance Degree Received, City, State Are you a convicted felon? Yes No How did you hear about Antioch University s PhD Program? Special Needs Please contact Vickie Nighswander at vnighswander@antioch.edu or (937) to request reasonable accommodation of disability at any time during your application to or participation in the PhD in Leadership and Change Program. International Students Please contact the Program Office for details about needed documentation. I certify that all information is true and accurate to the best of my knowledge. I further agree, if admitted to Antioch University, I will abide by and follow all of the University s policies and practices. My files may be electronically transmitted or duplicated for review and use by any authorized program faculty or staff. Signature Antioch University does not discriminate in its admissions, employment, financial aid, activities, or policy and procedures on the basis of age, race, color, gender, sexual orientation, religion, national origin, physical impairment, or political party affiliation or preferences. Date

5 Admissions Essay As part of the application process, please submit a typed essay (double spaced, no more than 10 pages) in which you: 1. Present a reflective autobiographical statement that discusses what has led you to want to be a doctoral student in the PhD in Leadership and Change Program (include such aspects as your relevant work experience, personal and professional interests, capacity to initiate and self-direct your learning and other appropriate information), 2. Discuss how you believe this PhD Program will enable you to become a more effective professional and principled leader in your field, 3. Discuss your overall interest and passion for future in-depth study during the individualized curriculum portion of our Program. Please include as much detail as you can regarding the ways in which you hope to focus on this area of interest, including what you are curious about and what you would like to learn, and 4. Relate and discuss a personal story that reflects your understanding of leadership and change in your professional field.

6 Computer Equipment and Skills Assessment Form A level of technology competency sufficient to function effectively in the program is required. If you are currently not at that necessary level, then you must have the willingness to obtain the needed competency. Please answer the following questions relating to your computer skills and equipment. The answers to these questions are meant to help us understand your current competency level. 1. What kind of computer do you use at home? Apple/Mac IBM/Compatible Other (please detail) 2. What kind of computer do you use at work? Apple/Mac IBM/Compatible Other (please detail) 3. What programs do you use for word processing? 4. What Internet service provider do you use? 5. Do you use regularly? Yes No 6. Are you comfortable using attachments or enclosures? Yes No 7. Do you ever use message boards or conferencing to communicate with others? Yes No 8. Do you browse websites? Yes No 9. Are you able to download and upload files with ease? Yes No 10. Have you ever taken classes or training on-line? Yes No 11. How would you rate your comfort level using computers? Very comfortable Comfortable Not comfortable at all

7 Confidential Recommendation for Doctoral Study Directions for the Applicant: Please print or type the information below. This form should then be given to individuals, such as professors and/or employment supervisors, who are able to comment on your qualification for doctoral study. This form is to be returned directly to Antioch University by the recommender. For the convenience of the recommender, please include a stamped envelope addressed to: Antioch University, 900 Dayton Street, Yellow Springs, OH PhD in Leadership and Change Program. Name of Recommender Applicant s Name Applicant s Complete Address Applicant s Home Phone Applicant s Address The applicant must complete this section before providing the form to the recommender. The Family Educational Rights and Privacy Act of 1974 and its amendments give registered students the right to see all references submitted with an application for admission, unless the right to such access has been waived. Recommendation letters received by the PhD Program Office without the signature of the applicant will be considered confidential. I do waive my right to inspect the contents of the following recommendation. I do not waive my right to inspect the contents of the following recommendation. Signature Date Directions for the Recommender: The above named person is applying for admissions to an interdisciplinary, intensive residency, cohort-based, competency-based PhD in Leadership and Change. The program places a strong emphasis on reflective practice, collaborative learning, interdisciplinary research and rigorous scholarship. We would appreciate your candid assessment of the applicant s potential for the successful completion of this program. Your comments will be held completely confidential if the applicant has waived his or her rights. Your comments are an important component of the applicant s admissions packet. If you need to use additional sheets of paper, please staple them to this form. If you have questions, please contact us at , toll-free or admissions.phdlc@antioch.edu. Your time and effort are very much appreciated.

8 Confidential Recommendation for Doctoral Study How long have you known the applicant? What is/was your relationship with the applicant? Please indicate the applicant s ability for the ten factors listed below. Below Unable to Factor Outstanding Good Average Average Evaluate Academic performance Knowledge of current professional field Ability to think critically Oral and written communication skills Openness to feedback Ability to work independently Flexibility Initiative Integrity Personal/professional reflection 1. What is your overall estimate of the applicant s promise as a graduate student and the applicant s ability to be a self-directed, independent learner? 2. What is your overall assessment of the applicant as a leader? Please comment on what you think are his/ her most significant and relevant strengths. Recommender s Signature Title Place of Work Work Phone Please forward this form to the PhD Program office (see address on first page) within two weeks of receipt. The PhD Program thanks you for your valuable assistance.

9 Confidential Recommendation for Doctoral Study Directions for the Applicant: Please print or type the information below. This form should then be given to individuals, such as professors and/or employment supervisors, who are able to comment on your qualification for doctoral study. This form is to be returned directly to Antioch University by the recommender. For the convenience of the recommender, please include a stamped envelope addressed to: Antioch University, 900 Dayton Street, Yellow Springs, OH PhD in Leadership and Change Program. Name of Recommender Applicant s Name Applicant s Complete Address Applicant s Home Phone Applicant s Address The applicant must complete this section before providing the form to the recommender. The Family Educational Rights and Privacy Act of 1974 and its amendments give registered students the right to see all references submitted with an application for admission, unless the right to such access has been waived. Recommendation letters received by the PhD Program Office without the signature of the applicant will be considered confidential. I do waive my right to inspect the contents of the following recommendation. I do not waive my right to inspect the contents of the following recommendation. Signature Date Directions for the Recommender: The above named person is applying for admissions to an interdisciplinary, intensive residency, cohort-based, competency-based PhD in Leadership and Change. The program places a strong emphasis on reflective practice, collaborative learning, interdisciplinary research and rigorous scholarship. We would appreciate your candid assessment of the applicant s potential for the successful completion of this program. Your comments will be held completely confidential if the applicant has waived his or her rights. Your comments are an important component of the applicant s admissions packet. If you need to use additional sheets of paper, please staple them to this form. If you have questions, please contact us at , toll-free or admissions.phdlc@antioch.edu. Your time and effort are very much appreciated.

10 Confidential Recommendation for Doctoral Study How long have you known the applicant? What is/was your relationship with the applicant? Please indicate the applicant s ability for the ten factors listed below. Below Unable to Factor Outstanding Good Average Average Evaluate Academic performance Knowledge of current professional field Ability to think critically Oral and written communication skills Openness to feedback Ability to work independently Flexibility Initiative Integrity Personal/professional reflection 1. What is your overall estimate of the applicant s promise as a graduate student and the applicant s ability to be a self-directed, independent learner? 2. What is your overall assessment of the applicant as a leader? Please comment on what you think are his/her most significant and relevant strengths. Recommender s Signature Title Place of Work Work Phone Please forward this form to the PhD Program office (see address on first page) within two weeks of receipt. The PhD Program thanks you for your valuable assistance.

11 Confidential Recommendation for Doctoral Study Directions for the Applicant: Please print or type the information below. This form should then be given to individuals, such as professors and/or employment supervisors, who are able to comment on your qualification for doctoral study. This form is to be returned directly to Antioch University by the recommender. For the convenience of the recommender, please include a stamped envelope addressed to: Antioch University, 900 Dayton Street, Yellow Springs, OH PhD in Leadership and Change Program. Name of Recommender Applicant s Name Applicant s Complete Address Applicant s Home Phone Applicant s Address The applicant must complete this section before providing the form to the recommender. The Family Educational Rights and Privacy Act of 1974 and its amendments give registered students the right to see all references submitted with an application for admission, unless the right to such access has been waived. Recommendation letters received by the PhD Program Office without the signature of the applicant will be considered confidential. I do waive my right to inspect the contents of the following recommendation. I do not waive my right to inspect the contents of the following recommendation. Signature Date Directions for the Recommender: The above named person is applying for admissions to an interdisciplinary, intensive residency, cohort-based, competency-based PhD in Leadership and Change. The program places a strong emphasis on reflective practice, collaborative learning, interdisciplinary research and rigorous scholarship. We would appreciate your candid assessment of the applicant s potential for the successful completion of this program. Your comments will be held completely confidential if the applicant has waived his or her rights. Your comments are an important component of the applicant s admissions packet. If you need to use additional sheets of paper, please staple them to this form. If you have questions, please contact us at , toll-free or admissions.phdlc@antioch.edu. Your time and effort are very much appreciated.

12 Confidential Recommendation for Doctoral Study How long have you known the applicant? What is/was your relationship with the applicant? Please indicate the applicant s ability for the ten factors listed below. Below Unable to Factor Outstanding Good Average Average Evaluate Academic performance Knowledge of current professional field Ability to think critically Oral and written communication skills Openness to feedback Ability to work independently Flexibility Initiative Integrity Personal/professional reflection 1. What is your overall estimate of the applicant s promise as a graduate student and the applicant s ability to be a self-directed, independent learner? 2. What is your overall assessment of the applicant as a leader? Please comment on what you think are his/ her most significant and relevant strengths. Recommender s Signature Title Place of Work Work Phone Please forward this form to the PhD Program office (see address on first page) within two weeks of receipt. The PhD Program thanks you for your valuable assistance.

13 Transcript Request Form Make copies as needed. To request that a transcript be sent from your former university or college to Antioch University, please complete both sections of this form. Check with your former school to find out about any fees that may be charged for sending out your official transcript(s). Send this completed form along with appropriate fees to each school you attended. Dear Alma Mater: Please send Antioch University an official transcript of my academic work while attending your institution and the Transcript Transmittal Form below. 1. I attended your school from to 2. While in attendance at your school, my name on your records was: Name (Last, First, Middle / Maiden) 3. My student identification number was Thank you for your assistance. Signature Date Transcript Transmittal Form Please return this form to Antioch University with transcripts. Social Security Number Date Name (Last, First, Middle / Maiden) Street Address City, State, Country, Zip Address Please send copy(ies) to: Antioch University, PhD in Leadership and Change Program, 900 Dayton Street, Yellow Springs, OH ( )

14 Tuition and Financial Aid Tuition and fees are competitively set and are subject to change each academic year, effective July 1. For the 2012/13 academic term, the annual tuition is set at $22,000. If you are interested in available payment plans please contact the Program Office. Tuition is charged on an annual basis until Candidacy is obtained. Once Candidacy is reached, tuition is half of the current pre-candidacy annual tuition and is charged on a quarterly basis. Those interested in applying for financial assistance through the Department of Education can complete the application electronically by going to fafsa.ed.gov. The school code for the PhD Program is The internet is an excellent starting point to search for scholarships and for sources of financial aid. Three websites to check are FastWeb (Financial Aid Search through the Web) the Financial Aid web page and You may also want to talk with professionals in your field to see if they have suggestions, contact your state s Department of Education, and do an internet search to locate foundation assistance that may be available for limited residency doctoral programs. In addition, please know that the PhD in Leadership and Change Program offers The Alan E. Guskin Scholarship Fund and the Returned Peace Corps Volunteer Scholarship to incoming students. In accordance with the commitment of Antioch University to encourage a socially engaged and humanistic education that helps to improve the quality of life for individuals, communities, and the larger global community, the two primary criteria for selection will be documented performance in service to a community and student need. Admission materials, financial need, and the scholarship application will be used as the basis for awarding the scholarship. Please note that all applicants for the scholarship must complete the FAFSA. To obtain further information regarding the Guskin and/or the Returned Peace Corps Scholarship, please contact the Program Office. As at any school, there are additional educational expenses, which vary from student to student, depending upon personal circumstances. The standard cost of attendance budget for the PhD Program is: Annual tuition: $22,000 Books/supplies/subscriptions: $1,000 Room & board: $2,200 (based on 14 nights x $100 for hotel; $50 a day for food) Transportation: $2,000 (based on 4 residencies x $500 transportation for each residency) Total = $27,200 Annual travel and accommodation expenses for residencies vary depending upon the residency location, the Program requirements, and any additional costs the student might incur as a result of the design of their competencies. Please don t hesitate to contact the Program Office if you have further questions or would like additional information.

15 Academic Residencies As an intensive residency doctoral program, attendance at four meetings a year is required and, we believe, critical to the student s success in the program. The requirement includes the week-long Summer residency and three weekend residencies each year until candidacy is reached. * The residencies are intense gatherings combining seminars, required workshops, guest lectures, student meetings with faculty, peer discussions, and student presentations. Integrative sessions are scheduled throughout the residency to help students make connection between the speakers and activities, their lived experiences, and the Core Curriculum s readings and presentations. A schedule of the residency activities will be posted on the Program website several months in advance of the gathering, including required work assignments and readings in preparation for the residency activity. Residency Dates and Locations Academic Term 2012/13 (residencies for 2013/14 will be held roughly around the same time throughout the year) July 30 August 3, 2012 October 11 14, 2012 January 17 20, 2013 March 21 24, 2013 Yellow Springs, Ohio Keene, New Hampshire Seattle, Washington Los Angeles, California For information or questions, contact the Program Office at or admissions.phdlc@antioch.edu. Residency locations and/or dates may be subject to change. * The PhD in Leadership and Change Program supports the fight against global warming by offsetting the climate impact of all work-related air travel by The Program s faculty and staff. Beginning in 2008, the Program s annual donations support projects involving renewable energy, energy efficiency, and reforestation.

16 Dayton Street Yellow Springs, OH 45387